What are dissociation and depersonalization?

Last updated
Wed 4 January 2017 Last updated Wed 4 Jan 2017

By Joseph Nordqvist

Reviewed by Timothy J. Legg, PMHNP-BC, GNP-BC, CARN-AP, MCHES

Depersonalization is a dreamlike feeling of being disengaged from one's surroundings. It leads to a sense that things are "less real" than they should be. People who experience depersonalization tend to feel detached from themselves.

Those who experience severe depersonalization say that it feels as if they are watching themselves act from a distance without having a sense of complete control. The person with this condition will be aware that these are only feelings and not reality.

A 2005 article in Advances in Psychiatric Treatment describes depersonalization as a "disturbing sense of being 'separate from oneself,' observing oneself as if from outside, feeling like a robot or automaton."

There may be "an unpleasant, chronic, and disabling alteration in the experience of self and environment."

Depersonalization is an aspect of dissociation, but while dissociation involves feeling detached from many things, depersonalization specifically refers to a sense of detachment from oneself and one's identity.

The National Alliance for Mental Illness note that almost half of all Americans experience dissociation at some time, but chronic depersonalization, leading to depersonalization disorder, is less common.

Dissociative amnesia, in which people may forget information about themselves or things that have happened to them

Depersonalization-derealization disorder, which can involve out-of-body experiences, a feeling of being unreal, and an inability to recognize one's image in a mirror. There may also be changes to bodily sensation and a reduced ability to act on an emotional level

Dissociative identity disorder, or "multiple personality disorder," where a person becomes confused about who they are and feel like a stranger to themselves. They may behave differently at different times or they may write in different handwriting.

In some cultures, people seek to attain depersonalization through religious or meditative practices. This is not a disorder.

Risk factors and symptoms

Clinically significant depersonalization is thought to affect between 1 and 2 percent of the general population.

Dissociation and depersonalization are ways of switching off from past trauma.

The average age at which the first experience occurs is 22.8 years, but 1 in 3 people with the condition notice it before the age of 16 years. It is more likely among adolescents or young adults. Those with
depression, multiple personality disorder, schizophrenia, and obsessive compulsive disorder are at higher risk.

Abuse of certain drugs may increase the risk, as does withdrawal from benzodiazepines or cannabis. While it is not sure that drugs cause the condition, using cannabis, for example, has been cited as a trigger in people who are susceptible.

It may also be that people with dissociative disorder are more likely to use drugs and alcohol to help them cope.

People who experience dissociation are likely to have memory loss or gaps in memory, especially of specific people, events, or periods in life.

People with dissociative disorders are more likely to display obsessive behavior. This may include self-harming or repeatedly looking in a mirror to check that they are real. The self-harming behavior may be related to the trauma rather than the lack of a sense of reality.

Anxiety is also common, whether as a cause or effect of dissociation.

If dissociation is a result of trauma, a flashback to the unwanted memory may trigger an episode.

During a dissociative episode, some people will have an out-of-body experience, in which they feel as if they are watching themselves as an observer, or watching their own life from a distance.

They may feel disconnected from their own body, and life may feel like a dream, where everyone around seems unreal. They may also feel that they are not in control of their actions.

For some people, an episode can involve physically traveling to a different place and taking on a different identity while there. The individual may not remember their own identity.

Diagnosis and treatment for depersonalization disorder

A doctor may diagnose dissociative disorder by asking a patient about their symptoms and their personal and medical history. Neurological tests may be necessary to rule out conditions such as epilepsy.

Reports suggest that a person with dissociative disorder will commonly use the expression "as if," in sentences like, "I feel as if I am not real," or "as if I am a robot."

The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) lists the following as diagnostic criteria for depersonalization disorder:

Feeling detached from one's mental processes or body

Intact reality testing

Clinical significantly distress, functional impairment, or both

Symptoms do not occur exclusively as a part of another disorder or due to the direct physiological effects of a substance

There is currently no treatment for depersonalization or dissociation, but antidepressants help to relieve symptoms in some people. Experts suggest that a combination of medications, specifically lamotrigine and a selective serotonin reuptake inhibitor (SSRI), may help.

Anecdotal evidence suggests that avoiding bright lights or keeping to a regular, monotonous routine may help some people to cope.

Cognitive behavior therapy (CBT) can help patients to view their symptoms in a nonthreatening way and to reduce the anxiety and obsessive behavior which often accompanies them.

Comments(35)

At the age of 16 my teacher died of heart attack. i did not know anything about heart attack then .i thought that the sudden stop of heart beating caused to death without any reason.

Suddenly my emotions were cut and I could not understand myself . I could not feel myself, my surroundings. I couldn't understand joy, distress, or anything like that .I lost interest in anything around me.

That state of mind continued for two years and i recovered slowly without any medicines. After two years when I failed for a subject in college the same symptoms developed again . I approached a psychiatrist and he prescribed some medicines for stopping anxiety. That worked and again I recovered from it .

After graduation I became a teacher and when I had to face more than fifty students in a class room, a stage fright developed in me and that anxiety again caused depersonalisation. That lasted for two years .

I consumed again the medicines for two months. I escaped from my disorder but that medicines caused some addiction in me . Slowly I lost sleep and I went mad .

Doctors diagnosed my illness as paranoid psychosis and I underwent electro Convelsive therapy for four times. At last i recovered and I continued medicines. after one year I stopped medicines.

But slowly without any reason I again went mad. again E C T applied . I am consuming a tablet daily at night for the last 30 years . I am now some what normal.

But the original identity of mine is lost. I am now working in an office . But still now i cant fully understand what i am. This is my problem. I am sure my mind is not like others. I cant understand what I am. I think I will never be like others in my life.

Can anybody help me in restoring my normal mind like every one? Please help me . Now I am 56. I have lived a disturbing life for all these days. i married but no issues. I think I am a failure in life . but I am sure I am not responsible for that. only the fate is the villain. I have no complaints. I am just living my life. And after all, this is life .That's all. Thank you,I am Sreekumar, Kerala, India.

I suffered from depersonalization 10 years ago for about 18 months. It was a very strange situation to be in, and one that I found it hard to explain to people (it wasn't so well known as a condition back then).

With the help of my doctor, a therapist and forums on the internet I found my way to a diagnosis of DP.

Family and friends stuck with me and I am now over it and leading a normal life. I have a website where I talk about my experiences, if anyone is interested in learning more: http://www.whyanxiety.com. Thanks.

This kind of thing scares me when I have it. I try not to see doctors about my mental status anymore. I used to have a psychiatrist for my depression and boy seeing how they use you as a pincushion for different medicines. I shudder to think what they would do if I told them I have had this, or that I hear voices..

I'm 14 years old, and I've had this since I was very little. I never knew what I was called until today. I thought it was just me, and that I was messed up. But this screws up everything, I'm depressed, I cry randomly, I get these feelings I can't explain or understand. And it's killing me inside, each and every day.

Nothing feels real though, and it's worse in public. It's like I'm watching a movie of myself from far away, and it seems like I never have control...the only time I don't get this is when I'm with my boyfriend, who I have a very comforting, loving relationship with..but I've never done drugs, been in a war, or had anything "that" traumitizing..I don't know. Im rambling now. I just need help :(

I have depersonalzation all my life but now its real bad i really dont no who i am anymore i feel like a walking zombie it wasnt that bad before but its real bad now im so scared i think my brain is giving up on me people look strange to me its only a mind game but its real

Hello I am 15 years old and I have been suffering from Depersonalization for many years but I never truly realised this till a few years ago when I stumbled on a page for the disorder. I have been diagnosed with PTSD and Depression and this is due to traumatic events in my life mostly involving my father.

The symptoms of my Depersonalization are: feeling as if my life is inside a dream, as if nothing truly exists and all my senses are numb. When you watch TV you become engrossed in the program and you feel as if you are actually there watching it, however there is always an inkling that none of it is actually real, that is what Depersonalization feels like.

I understand that I am real and that I am an actual human being on this earth nevertheless I do not have the connection with the world and my self that most people have, it is as if my mind is in a bubble in my brain and it cant get out. My actions like playing sports, socialising, studying etc... all feel robotic as if they all come naturally with no realisation that I am actually doing it. This all sums up my experience of Depersonalization in a nut shell.

I am at a complete loss for this disorder. My husband was diagnosed with this disorder a couple days ago after spending 4 days in the hospital. He passed out, he also acts like he has multiple personalities, he keeps asking what is going on or doesn't remember anythingt that happened. Is it normal to sleep throughout the entire day? I don't know how to snap him out of this depression mood and back to real life.

He is unable to work, function, take care of our 2 year old son, etc. what did you all do to get yourselves out of this funk? Do you take medication of any sort? This is ruining our marriage and I dont know how long I will be able to deal with this. A way I can describe it is... His mind is in a coma but he physically is not, he is walking, eating, etc. HELP ME PLEASE!!!!!!!

Hello, I am so sorry to hear about your husband's problems. I have an inner ear problems that seems to cause the derealization. It's difficult for me to do things around the house because when I feel like I'm dreaming, I'm afraid I'm going to pass out. I am taking Klonopin which my inner ear doctor just prescribed me last week. I would say to please take your husband to a neurologist, something like and MRI to check his brain to make sure it's functioning ok. I've heard some people with frontal lobe problems can experience this. Also, if the neurologist gives your husband a clean bill of health, check with a psychiatrist. I hope and pray your questions will be answered and he will be healthy again soon. Keep us posted please.

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